Carotid Artery Disease

Carotid arteries are a pair of large blood vessels present in the neck. They supply blood to the brain. When these arteries get blocked, it leads to a condition known as carotid artery disease. In this disease, the arteries become narrow due to atherosclerosis, in which plaque, made up of cholesterol and calcium, deposits on the inner lining of these arteries, causing the arteries to harden. Due to the presence of plaque, the blood flow is restricted and oxygen supply to the brain cells is reduced.

Some of the risk factors that can cause carotid artery disease include obesity, high blood pressure and high cholesterol levels, family history of stroke, smoking, drug abuse, kidney diseases, diabetes and excessive alcohol consumption.

Narrowing of the artery causes stroke and transient ischemic attack (TIA), which includes symptoms such as blurred vision, loss of memory and sensation, problems in speech and language, and weakness in one part of the body.

Your doctor will request for some blood tests to check for elevated levels of cholesterol, triglycerides and glucose. Other diagnostic tests, such as ultrasound of the carotid arteries, carotid or cerebral angiography, magnetic resonance angiography (MRA) and computerized tomographic angiography (CTA), are done to examine the blood vessels of the neck and brain.

Treatment

Surgery is the only effective way to treat patients with carotid artery disease. Medications will help to control the level of triglycerides and cholesterols. Blood thinning medicines like aspirin and warfarin are suggested to lower the risk of stroke.

Carotid endarterectomy is a standard surgery to treat individuals with carotid artery disease. It helps to remove plaque from the artery of the neck and restore the proper blood flow to the brain. In this procedure, an incision is made in the neck and a catheter (flexible tube) is inserted, through which blood will flow to the blocked artery. The external and internal carotid arteries are separated from the surrounding tissues. Heparin is injected into the blood to prevent blood clotting during surgery. The artery wall is opened, and the blockage will be cleared. Your doctor will decide if grafting is required to patch the blood vessel to expand the diameter of the vessel and later the incisions are closed.

The other two procedures performed in these patients are balloon angioplasty and stenting.

Balloon angioplasty– Your surgeon will insert a small deflated balloon into the blocked artery. The balloon is then inflated to push the plaque against the artery wall and allow more space to increase the blood flow.

Stenting– Stenting is performed during the angioplasty procedure. Stents are mounted on a narrow tube (catheter), which has a deflated balloon towards the end. The stent is a mesh-like tube made up of stainless-steel which can expand inside the blocked artery. This stent is inserted into the blocked artery, as the balloon inflates, the stent will expand by keeping the artery open. Later, the balloon is deflated and removed.

The possible complications of surgery are heart attack and stroke. Stroke occur when the blood supply to the brain is blocked (ischemic) or the blood vessels in the brain bursts (hemorrhagic). If stroke symptoms are observed for more than 24 hours, then it may lead to heart attack. Symptoms of stroke are numbness or weakness on one side of the body, sudden confusion or trouble while speaking, understanding speech and while walking, dizziness, loss of balance, and sudden severe headache without any cause.